ACCS Oakes practice Exam Questions
and Answers 2025-2026
A difficult intubation is anticipated with an obese pt. The decision is made to intubate by
video laryngoscopy. Which of the following is LEAST likely to be needed:
A) Cook's Exchanger
B) Rigid Stylet
C) Cuffed Endotracheal Tube
D) Video-enabled Laryngoscope - Correct Answer A) cook's exchanger
Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid stylet, as
well as a video-enabled laryngoscope and other normal intubation equipment.
A Cook's Tube Exchanger is not necessary - this is used to exchange tubes already in place.
A 5'6" female has been transferred from Intermediate Care to Intensive Care in respiratory
distress. She is intubated with a silver-coated #7.0 Endotracheal tube. CXR immediately
following intubation shows Right Upper Lobe infiltrate with bibasilar atelectasis. The ET
Tube is noted to be approximately 4 cm above the carina.
The Respiratory Therapist would BEST recommend:
A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-
pressure/high-volume cuffed tube
D) Immediate V/Q Scan - Correct Answer Correct Answer is A
This pt has gone into respiratory failure, requiring intubation. The X-ray is consistent with a
possible pneumonia diagnosis. The best option therefore is to start antibiotics.
,ACCS Oakes practice Exam Questions
and Answers 2025-2026
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3 cm could
result in inadvertent extubation and would cause harm to patient
Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is intended to
help prevent VAP
Immediate V/Q scan is not indicated - it is a poor use of resources for what is needed right
away.
You are part of Physician Rounding this morning, and consulting on a patient who is
currently on APRV. They were originally admitted with a pneumonia which developed into
ARDS with a P/F ratio as low as 110. The patient was transitioned to APRV from PC due to
an elevated Plateau Pressure required to maintain VT around 4 cc/kg IBW. The patient is
arousable and taking breaths on their own. The physician has asked you what should be
done to address the patient's latest ABG.
Ph 7.16
PaCo2 49
PaO2 88 torr
HCO3 19
Mode- APRV
Phigh- 24
Plow- 0
Thigh- 5.0 sec
Tlow- o.5 sec
, ACCS Oakes practice Exam Questions
and Answers 2025-2026
PS- 26
FiO2- 80%
A) Increase Phigh to 28 cmH2O
B) Decrease Phigh to 20 cmH2O
C) Increase sedation
D) Increase Thigh to 6.0 sec - Correct Answer Correct Answer is A
This ABG may look deceptively metabolic but is truly a mixed Respiratory and Metabolic
Acidosis. The PaCO2 has risen, slightly, as a result of the Metabolic Acidosis. The correct
solution is to increase Phigh to 28 cmH2O (increasing your delta-P to increase minute
volume. Decreasing Phigh will decrease minute volume. Increasing Thigh will increase MAP
(good if oxygenation), but will also lower the number of "releases" - which are primarily
responsible for dumping CO2. Increasing sedation in a patient who is spontaneously
breathing on APRV will result in a lowered minute volume and worsening acidosis. While
controversy exists, you may also consider increasing PS if the pt is breathing
spontaneously.
A 56-year old woman was admitted for rapid development of respiratory failure following a
suspected aspiration. Her past medical history includes Diabetes, medication-controlled
Hypertension, and she has a 30-pack year smoking history.
She has been intubated and placed on a Ventilator.
Patient data
Ph 7.19
PaCO2 62 mmHg
PaO2 54 mmHg
and Answers 2025-2026
A difficult intubation is anticipated with an obese pt. The decision is made to intubate by
video laryngoscopy. Which of the following is LEAST likely to be needed:
A) Cook's Exchanger
B) Rigid Stylet
C) Cuffed Endotracheal Tube
D) Video-enabled Laryngoscope - Correct Answer A) cook's exchanger
Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid stylet, as
well as a video-enabled laryngoscope and other normal intubation equipment.
A Cook's Tube Exchanger is not necessary - this is used to exchange tubes already in place.
A 5'6" female has been transferred from Intermediate Care to Intensive Care in respiratory
distress. She is intubated with a silver-coated #7.0 Endotracheal tube. CXR immediately
following intubation shows Right Upper Lobe infiltrate with bibasilar atelectasis. The ET
Tube is noted to be approximately 4 cm above the carina.
The Respiratory Therapist would BEST recommend:
A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-
pressure/high-volume cuffed tube
D) Immediate V/Q Scan - Correct Answer Correct Answer is A
This pt has gone into respiratory failure, requiring intubation. The X-ray is consistent with a
possible pneumonia diagnosis. The best option therefore is to start antibiotics.
,ACCS Oakes practice Exam Questions
and Answers 2025-2026
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3 cm could
result in inadvertent extubation and would cause harm to patient
Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is intended to
help prevent VAP
Immediate V/Q scan is not indicated - it is a poor use of resources for what is needed right
away.
You are part of Physician Rounding this morning, and consulting on a patient who is
currently on APRV. They were originally admitted with a pneumonia which developed into
ARDS with a P/F ratio as low as 110. The patient was transitioned to APRV from PC due to
an elevated Plateau Pressure required to maintain VT around 4 cc/kg IBW. The patient is
arousable and taking breaths on their own. The physician has asked you what should be
done to address the patient's latest ABG.
Ph 7.16
PaCo2 49
PaO2 88 torr
HCO3 19
Mode- APRV
Phigh- 24
Plow- 0
Thigh- 5.0 sec
Tlow- o.5 sec
, ACCS Oakes practice Exam Questions
and Answers 2025-2026
PS- 26
FiO2- 80%
A) Increase Phigh to 28 cmH2O
B) Decrease Phigh to 20 cmH2O
C) Increase sedation
D) Increase Thigh to 6.0 sec - Correct Answer Correct Answer is A
This ABG may look deceptively metabolic but is truly a mixed Respiratory and Metabolic
Acidosis. The PaCO2 has risen, slightly, as a result of the Metabolic Acidosis. The correct
solution is to increase Phigh to 28 cmH2O (increasing your delta-P to increase minute
volume. Decreasing Phigh will decrease minute volume. Increasing Thigh will increase MAP
(good if oxygenation), but will also lower the number of "releases" - which are primarily
responsible for dumping CO2. Increasing sedation in a patient who is spontaneously
breathing on APRV will result in a lowered minute volume and worsening acidosis. While
controversy exists, you may also consider increasing PS if the pt is breathing
spontaneously.
A 56-year old woman was admitted for rapid development of respiratory failure following a
suspected aspiration. Her past medical history includes Diabetes, medication-controlled
Hypertension, and she has a 30-pack year smoking history.
She has been intubated and placed on a Ventilator.
Patient data
Ph 7.19
PaCO2 62 mmHg
PaO2 54 mmHg
